从术后功能状态评价保留迷走神经、幽门的胃切除术

Evaluation function of pylorus perserving gastrectomy with preservation of vagal nerve

目的探讨保留迷走神经、幽门的胃切除手术的术后残胃功能状态。方法对保留迷走神经、幽门的胃切除术病例（ＰＰＧ）（１７例）、远端胃切除病例（１５例）的胃排空功能、胆囊收缩功能、ＣＣＫ分泌状态进行对比分析。结果保留迷走神经、幽门的胃切除术组病人的胃排空状态类似于术前；而远端胃切除组则呈坠落状态。胆囊收缩动态测定显示进食６０ｍｉｎ后，ＰＰＧ组胆囊收缩率为４０％，而远端胃切除组为２３％（Ｐ＜０．０５）。ＣＣＫ值测定显示ＰＰＧ组变化幅度小，ＤＲ组１５ｍｉｎ时明显升高后很快下降。结论ＰＰＧ手术组病人具有近于正常的胃排空功能和胆囊收缩功能，是胃切除术中具有保留胃和胆囊功能。

Objective To invastigate the functional status of residual stomach in pylorus preserving gastrectomy with preservation of the vagal nerve. Methods Functions of gastric emptying, contraction of the gallbladder and CCK secretion were evaluated after the operation in 17 patients undergoing PPG, and 15 patients undergoing conventional distal gastrectomy(DG). Results The postoperative gastric emptying function in PPG group showed similar to the preoperative status. However this functions in DG group appeared as a “falling down' status. Measuring the contraction of the gallbladder showed that 60min after intaking food, the contracing rate was 40% in PPG group, while 23% in DG group ( P <0.05). Investigating CCK secretion showed that small change happened in PPG group, while in DG group, the CCK secretion increased obviously at 15min after intaking food, but afterward it decreased rapidly.Conclusions The functions of gastric emptying and contraction of the gallbladder are almost normal in PPG group. PPG can preserve the functions of stomach and gallbladder, and can improve the QOL of patients. So PPG is useful for patients with gastric ulcer or early stage of gastric cancer.